The Harvard Community Health Plan (HCHP) and the Laboratory of Computer Science (LCS) of the Massachusetts General Hospital propose to develop a quality assurance program with certain unique characteristics for the HCHP health maintenance organization. The broad objectives of the proposal are: a) to develop as an integral component of the health care delivery system a quality assurance program which uses both process and outcome methadologies and meets the formal requirements of P.L. 93-222 (the HMO Act of 1973) for a quality assurance program, b) to demonstrate the usefulness of a computerized ambulatory medical record system in monitoring compliance with the requirements for good care established by the quality assurance program, c) to document the impact on provider and system behavior of concurrent feedback to the provider regarding individual patients in which inaequate compliance with agreed-upon standards is detected; d) to report the experience derived from the proposed quality assurance program to assist other health maintenance organizations, as well as PSRO's involved in quality assessment of ambulatory care, in preparing programs suited to their own practice settings.